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Your Workers' Compensation Claim Denied - What Next?

Summary:
If your workers' compensation claim is denied, it is important to understand how to file an appeal.

Most employees in the state of Missouri are covered under the workers’ compensation system
for injuries and illnesses that are directly work-related. The workers’
compensation system provides for compensation for medical expenses and
wage loss caused by injuries sustained at work and illnesses that are
related to workplace conditions. It is a no-fault system and provides
coverage to covered workers only.

Filing a Workers' Compensation Claim

If you have sustained a work-related injury or illness,
the first step is to file your claim with the Division of Workers’
Compensation. If your claim is accepted and approved, you will start to
receive your compensation benefits. Missouri workers' compensation
attorneys inform us that in many cases, valid compensation claims are
rejected. Most people think of this as the end of the road and do not
pursue it further. In the event your compensation claim is denied, you
may file for appeal against the denial.

Filing For an Appeal

Before
you file for an appeal, you must read the notice thoroughly to know the
reason for denial and discuss your case with an experienced Missouri
worker’s compensation attorney who can guide you through the process.
The following information will be relevant to your case and you can file
your appeal accordingly.

The Grounds for Denial - The
compensation denial notice provides the reason why your claim has been
denied. Some of the common reasons for denial are – incomplete
application or inadequate information, employer is not required to
provide compensation coverage, you have not obtained coverage or you are
not a covered worker, the injury or illness is not work-related, or the
injury was caused due to intoxication.

Employer Provides Coverage - The
general rule states that all employers who employ more than five
employees are required to provide workers’ compensation coverage.
Employers who are not required to provide coverage may purchase coverage
if they wish to.

Covered Worker - Missouri
workers’ compensation laws cover most employees. However, there are
certain workers which are not covered by workers’ compensation. These
are – domestic servants, real-estate agents, commercial carrier owners
and operators, independent contractors, and workers covered under some
other compensation system like the federal system.

Injury is Work-Related - Injuries
sustained at workplace and illnesses contracted due to the workplace
conditions are covered under the Missouri workers’ compensation system.
Conditions which have pre-existed are not covered; however, if a
pre-existing condition has worsened due to workplace conditions, you
will be eligible to receive compensation benefits. Accidents that happen
while traveling to and from from work are not covered but this clause
may have some exceptions.

Time Limit - The
Missouri workers’ compensation system has a statute of limitations of
two years. Therefore, all compensation claim cases should be filed
within this period after the injury. Claims filed after this period will
be denied.

The Next Step - When you
file an appeal, you are informing the Dispute Management Unit of the
Compensation Division that you disagree with the denial of your claim.

At this stage it is advisable to consult with an experienced Missouri workers' compensation attorney to represent you so that your rights are protected.

Call The Law Office of James M. Hoffmann at (314) 361-4300 for a free consultation.

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